[Tiny addition 3/18/12.]
[Preliminary note: The Star-Ledger, the main newspaper of New Jersey, had an editorial
running on March 9 remarking on a proposal by U.S. Rep. Leonard Lance, from New
Jersey (7th Dist.), to expand access to mental health services
nationwide. His announcement included the remark, quoted in the Ledger editorial (and I believe
identical in another article on this proposal), that the legislation would “serve
as many Americans as possible, given that mental health is a significant
component of the larger gun issue.” The editorial criticizes Lance’s proposal
as offering too little money per state, and while I have always objected to the
idea of mental health issues’ being so efficiently addressed by (increased) money
amounts—at times it comes down to no less crass an idea as “Gimme more money
for mental health!”—I think the Ledger
editorial has a point, underscoring (I suggest) this proposal’s conforming with
the more general conservative Republican tendency—a signature one—of being
cheap about everything except defense. But politics aside, I think the problem with this legislative idea is even more
fundamental, and offensive, and that is subordinating
the interests of mental health to the issue of guns. This obviously can
play into the hands—quite understandably—of those who would characterize
American culture as proto-fascist (especially in recent times) to the extent
that gun rights are so vehemently and widely defended, even while mental health
(and other human-interest) issues are given relative short shrift. One could
also say that, as with other areas of intricate and rarefied qualities,
education is key to addressing the matter; and while it takes education to
understand mental health issues more properly on their own terms, it doesn’t
take an advanced education to identify people who speak about these issues like
peasants, or even professionals in the mental health field who are
substandard.]
Subsections below:
Some examples in local media of ham-handed discussion of mental illness
and related public need
Some initial responses to the media discussion
1. Not every case of “mental illness” is
the same.
2. Not every person suffering long-term
from a mental disorder is a danger to society.
3. More “intrusive” legal means, inherently
“systematizing,” may be insufficient to address the many variables of a specific
case of mental illness.
4. An “impolite” analogy helps us see the
problem of overgeneralizing a “cure” for a problem that may not exist.
(“Takeaway” statement is at the
end of this entry.)
The discussion about “serious
mental illness” and trying to forestall future problems such as the horrific
shooting of students and adults in Newtown,
Conn., in December 2012
continues, and its deficient nature keeps on. I have thought to comment, and
held off about doing so, several times. Doing so now doesn’t mean I’ll say all
I would want to, but it will be a good start.
First of all, a lot of the
discussion—even the terms to use for what is at issue—has been wrongheaded or
oversimplifying.
Some examples in local media of ham-handed discussion of mental illness
and related public need
In The
New Jersey Herald, a Sussex
County newspaper
One of the worst screeds I’ve
seen exhibiting this sort of thing was a column in The New Jersey Herald this past January 17, by an attorney, Ernest
Hemschot, who works in Newton,
N.J., and also has readily
admitted he has suffered from bipolar disorder. I have been in touch with this
man in the past, over a freelance-work-query-related matter (I never worked for
him), and I have been aware of him in the county advocating for mental health
issues for some years, though I never met him. He had served as chairman of the
county Board of Mental Health. His January 17
column includes a lot of generalizations about “mental illness,” such as in this
sentence (p. A-7): “Mental illness treatment in the 1980s consisted of two
options: Lock up the patient in an institution indefinitely, or allow them to
roam the streets untreated.” This statement is untrue on several counts,
including the options for what got done with mentally ill people—he sounds as
if he is talking about serious mental illness, but he doesn’t make this clear,
and even if he was, his statement as presented would be false. I majored in
psychology in that decade, and I knew what the system was like, good and bad. I
will address his column more extensively in another blog entry, hopefully.
There was also a letter to the
editor in the same newspaper (different issue), much shorter than Mr.
Hemschot’s fairly rigorous column, that was objectionable for showing a
layperson’s ignorance. I won’t quote or cite date and page number for this one
(partly to spare the man national embarrassment), but he seemed to show the
level of stupidity that gun supporters (which he was obviously one of) can get
to, such as when this man boldly embraced the word lunatic and then gnashed his rhetorical teeth as he said the
solution was to deal with the lunatics, etc.
In The
Star-Ledger, the state-level newspaper, in a competent attempt
More responsible, but still
problematic, was the recent front-page story in the Sunday Star-Ledger, the Sunday edition of New Jersey’s main
newspaper, with the headline “N.J.’s New Frontier on Mental Illness: Committed
to Heal / Under controversial law, judges can order outpatient treatment for
those who pose a danger” (February 24). This story was interesting for showing,
in some detail, a “case in point” (as journalists like to say, though this
wasn’t said here) that illustrates why the newly financed law (it had been on
the books but languishing for lack of funds) would be good. Well, wouldn’t it
be nice if the state found some glowing results from a law that might prevent
someone from going to shoot up a classroom full of kids?
The only problem is, this whole
proposition relies on an awful lot of assumptions that, if examined, run from
the crude to the naïve to the offensive, and most generally it fails to reflect
that mental illness is not a highly generalizable, eminently treatable thing.
As I have said before, such as
in my blog entries (December 15, both blogs) related to the Newtown shooting, mental illness is a highly
contingent, variable thing. As such, it is less amenable to “easy,” blanket
attempts at mitigation than might be a bold change to gun laws.
Of course, we’ve seen in the
past two-plus months how easy it is to change gun laws.
My own view on mental illness,
to the extent I would address the public about it, is that it makes more sense
to try to educate people about it, and especially not give any false hopes as
if there are easy answers for it, while also orienting my discussion to how
people with mental illness have dignity, freedom, and rights, and if some of
them were approached this way, rather than as a gross liability, this could
actually be better for them, and those with whom they are involved, than doing
otherwise.
The February 24 Ledger story is a sort of case study—to
the extent it looks at one troubled young man, with glances at how related
programs are faring in some locations in the state, and sees how well the
“outpatient commitment” law might serve the ends of such a person.
Case studies can be good or bad,
no matter what kind of “case” is presented. For me, when I write long “studies”
of some individuals who deal with mental illness, the risk is that it could
well not be relatable to a host of people (while it could be so to others), but
the benefit is that it draws out the implications of this person’s travails in
the best phenomenological sense—meaning, what can be seen of how this functions
in the world? How does this person’s struggle relate to family? To a job? To
his longer-term goals? To how “the system” is capable of serving him or not?
You can see a story—such as I
might write—showing how that person irons out some of his problems on his own
(or still suffers despair, reflecting some of the nature of life in any
event)…. Or, as in the Ledger’s case,
you see a man’s problems as they can be addressed by the mental-health
outpatient commitment court. “See how such a law and court can nip a big
problem in the bud?” the story seems to ask.
Some initial responses to the media discussion
Actually, let’s consider a few
things—and realize that the Ledger’s
February 24 case story may be on the “sui generis” side—that is, valid for a
very limited number of cases, but not to a host of what falls under the
umbrella of “mental illness”:
1. Not every case of “mental illness” is the same.
“Neurosis” type disorders, or
dysthymia. Some cases can be of anxiety disorder—the person suffers
anxiety in interpersonal relations, or is afraid of animals or bugs, or of
heights. Some can be of dysthymia—a low-grade depression that is somewhat
debilitating but does not prevent the person from functioning in society.
Long-term depression. Some
can be of “major depression,” or “clinical depression” (the two terms are
almost interchangeable)—serious-enough, and/or long-term-enough, depression
that interferes with the sufferer’s life in major ways.
Bipolar disorder (types 1 and 2).
Some can be of a form of bipolar disorder—which has had two main types, 1 and
2, though the relevant “nosology” (framework of differently diagnosing) is
supposed to be expanding, from what I heard a few years ago. This disorder is
usually a lifelong condition usually including depression but also including
some “manic” traits, which can vary from (at one extreme) the full-blown,
maybe-euphoria-featuring psychotic mania that gets onlookers aghast at the
person’s “going off the rails” (this is central to characterizing bipolar type
1), to lesser manic traits such as “hypomania,” which can be a sort of euphoric
state that allows increased activity but is also pathological in some way, to
the not-really-euphoric manic traits of sharp irritability, explosive anger,
and the like that seem to have more in common with the depressive type of
traits (these two lesser types of “mania” usually are seen in bipolar type 2).
Personality disorders. A
person can have a personality disorder, which comes in about 10 or 12 different
types (some of which have overlap in traits), which means a tendency to
dysfunction that is seen over time, and means the person can be normal at some
times, “neurotic” at other times, and at certain unusual points “psychotic.”
The person typically would be most apt to show him or herself “psychotic” when
under extreme stress.
The most distinctive, and most
troubling in the concrete, personality disorder is that of borderline
personality, which can sometimes resemble a disturbed version of bipolar
disorder type 2, or alternatively something involving depression. Jerome Kroll,
M.D., who has written elegantly and authoritatively on the disorder, has said
in describing how the “borderline” category developed over the past several
decades:
The single and
only enduring strength of the concept of pseudoneurotic schizophrenia was that
it seemed to describe a group of patients who were recognizable in broad
outline by practicing psychiatrists and psychologists. These patients presented
a peculiar combination of contradictory symptoms and treatment responses. At
times they appeared normal, at times neurotic, at times characterologically
disturbed, and at times psychotic. (Jerome Kroll, The Challenge of the Borderline Patient: Competency in Diagnosis and
Treatment [New York: W.W. Norton & Company, Inc., 1988], pp. 14-15)
The category that more or less
took over the role of “pseudoneurotic schizophrenia” was “borderline
personality” (Ibid., p. 15). A new
concept—“borderline” personality, a shortening of “borderline schizophrenia” (Ibid., p. 15)—would group these patients
without making such a direct connection, on a general level, with
schizophrenia.
Further, the victimization
theme, as Kroll argues in his book, is pretty central to borderlines. “It is
the playing out of...themes of victimization that produces in large part the
intense and unstable interpersonal relationships so characteristic of the
borderline” (Ibid., p. 46).
For his part, Ivan K. Goldberg,
M.D., who spoke in a presentation I arranged about a decade ago, described the
most disturbing—and in a way, the signature—feature of borderline patients, the
tendency to abruptly cut off friendships or other close-seeming associations:
The other thing
that's sort of so difficult when dealing with borderline people is their
capacity to upset others. As kind of a survival skill...from their early
traumatic childhoods, they've learned all kinds of emotional techniques that
basically get under the skin of other people and make other people sort of
impotently furious in many cases. So a good deal of anger is generally
expressed by such folks [borderlines]--they can rapidly alternate between
loving you and hating you. You have someone who has apparently been your best
friend for a long, long time, and then suddenly, over what appears to you to be
an absolutely trivial incident, ...you're at the top of their shit list.
(spoken at Newton Memorial Hospital,
under the aegis of DBSA
Sussex County
and NAMI Sussex, June 6, 2003)
So we can see that personality
disorders encompass a complex set of traits of their own. And it would appear
that not all these people would be subject—unless their circumstances were
extreme—to the possible application of an “outpatient commitment” court
proceeding.
Schizophrenia can also be
among cases of mental illness. The most common thumbnail sketch of what this
means is “thought disorder,” such as fairly obviously paranoid delusions. In an
unfortunate development, this disorder seems to be what people most commonly
think of when considering a severely mentally ill person in the news, which is different
from when there was so much liberalization about this disorder back in the
1970s (consider just the title of this popularly oriented book: The Schizophrenias: Yours and Mine,
authored by The Professional Committee of the Schizophrenia Foundation of New
Jersey, Carl C. Pfeiffer, Ph.D., M.D., Chairman [New York: Jove/Harcourt Brace
Jovanovich, 1970]). However, as treatment and understanding of the various
serious mental illnesses have grown, it has become clear that there can be
quite a bit of overlap in symptoms between individuals with either bipolar
disorder (a mood disorder) or schizophrenia, not that a given individual
inevitably has both. Consider this quote: “Although most maniacal delusions are
grandiose, they may also be paranoid in content. Many psychiatric professionals
mistakenly assume that the presence of paranoid delusions automatically
qualifies the person for a diagnosis of paranoid schizophrenia. [But a]s early
as 1973, a study of patients with mania reported that 60 percent had grandiose
delusions, 42 percent had paranoid delusions, and many had both. ... Other
researchers, too, have reported that paranoid delusions are commonly found in
manic-depressive illness” (E. Fuller Torrey and Michael B. Knable, Surviving Manic Depression: A Manual on
Bipolar Disorder for Patients, Families, and Providers [New York: Basic
Books, 2002], pp. 27-28.)
As is obvious from this range of
problems,
2. Not every person suffering long-term from a mental disorder is a
danger to society.
Now consider: if someone has
borderline personality disorder, and is temporarily under extreme stress and
shows some circumstantially oriented paranoia, are there any grounds to say
this person will pose a danger to self and/or others? And how (based on what
heuristics to gather facts) might we know this?
We can know by looking at the
person’s circumstances. Is he with family? Did she lose her job? Is there
substance abuse involved? Has the person ever been seriously violent before? If
his or her stress-inducing problem is addressed by common-sense, respectful
means, might that reduce the “paranoia” and mean, essentially, there is no
“dangerous” issue (i.e., a potential for violence to a range of outsiders) stemming
from “apparent paranoia”?
Obviously, people don’t show
distrait states in a vacuum. There are circumstances to consider. Some people
might be better equipped to deal with this than others. Some who know the
person better—through personal familiarity, interaction with that person in a job,
knowledge of the person (through thick and thin) over years—might be better
qualified to say what “danger” this person poses than a judge who never heard
of the person before he or she was hauled into “outpatient commitment” court.
3. More “intrusive” legal means, inherently “systematizing,” may be
insufficient to address the many variables of a specific case of mental illness.
I think it doesn’t take much
brains, or citing of examples, to see that to talk about the issue of mental
illness as occasioning use of a court mechanism to enforce a health-care
intervention risks extreme
oversimplification. Mental illness, as broadly labeled, can in the concrete
be so variable (1) as to level of severity, (2) as to whether it is
circumstantially potentiated, and/or (3) as to how amenable it is to non-legal
intervention, that law—with its generalizing tendencies in all sorts of
contexts, and carried out by local functionaries whose qualifications to deal
with such intricate matters may be quite limited—may be inherently ill-equipped
to deal with this matter.
Mental illness was always the
province of doctors before. Courts only got involved—with “involuntary
commitment”—when the person clearly posed an imminent danger—the sort of
standard that now people seem to fuss at, as if it’s clearly deficient.
Statistics reported recently in newspapers show the low potential for
violence emanating from the mentally ill seen as a total group. Mentally
ill persons have been involved in only about 4 percent of violent crimes, and
are at least 11 times more likely to be the victim of a violent crime than the
general population, according to an article in The New York Times (February 1, 2013), p. A13. (The 4 percent
statistic was also mentioned in an article in the Times on January 16, 2013, p. A15.) Weapons only feature in 2
percent of those violent crimes committed by the mentally ill (The New York Times [February 1, 2013],
p. A19). [I need to double-check on the dates of the February 1 articles referenced here.]
When (in a future entry) I look
at Mr. Hemschot’s January 2013 letter, which I referenced above, we will see
the trouble with specific language in trying to address the issues of how a
person’s rights are respected in the intervention of an “outpatient treatment”
court. In fact, in my opinion, there are a lot of ambiguities, and sometimes
downright tortured language, in the attempts at articulately addressing of this
area.
4. An “impolite” analogy helps us see the problem of overgeneralizing a
“cure” for a problem that may not exist.
People considered the Newtown shootings and
were as horrified as they were saddened. So was I. We would like to prevent
another such shooting. We can’t bring those particular kids back, but we can
protect future kids similarly situated. But are there such easy ways to
identify “mental illness” and apply appropriate “means to forestall a problem”?
Let’s analogize. With mental
illness, we are talking about a subgroup
of people, and the concerns about violence appertain only to a few bad apples who
bring ill repute to the subgroup by their horrendous acts.
Let’s take another subgroup of
people. They’re a somewhat self-contained, or self-consciously self-identifying
group, by and large. Some people don’t like them; others do and go to great
lengths to protect them or the memory of atrocities against their forebears.
But look…many notable
individuals have come out of their group: the philosophers Benedict de Spinoza,
Moses Maimonides, and Karl Marx; the musicians Bernard Herrmann, Gyorgy Ligeti, Donald Fagen and Walter Becker (the latter two from the rock group
Steely Dan), among many others;
writers Norman Mailer, Philip Roth, Joseph Heller, Saul Bellow, Cynthia Ozick, Victoria
Strauss, and many others;
actors/performers Goldie Hawn, Barbra Streisand, Adam Sandler, Tony Randall,
Jack Klugman, and many others; film
directors (past and present) Billy Wilder, Stanley Kubrick, Joel and Ethan
Coen, and many others; American
federal-level politicians, statesmen, or jurists including Henry Kissinger,
Paul Wolfowitz, Felix Frankfurter, Ruth Bader Ginsburg, Steven Breyer,
and many others.
I think many names ago, your
brow might have started to go up. What am I getting at?
Take a look. Bad apples:
Bernard Madoff: an architect of
massive financial fraud. Famous now for a Ponzi scheme that ran out of
his company’s hedge-fund division that was worth about $65 billion on paper (the court-appointed trustee in the case
estimated actual losses to investors at $18
billion, according to the Wikipedia article on him). This scheme
notably victimizing a large number of the clients of the hedge fund who were
Jewish: so it was an affinity fraud perpetrated by a Jewish man against other
Jews, including Holocaust writer Elie Wiesel.
Jonathan Pollard—traitor
to the U.S.
He has been jailed since the late 1980s for having passed an apparently
enormous and critical set of U.S.
state secrets to Israel, on
the premise that it was good for Israel. Appeals for clemency for
him have gone to (I believe, but am not sure) every U.S. president since Ronald Reagan,
and these appeals have all been denied. Other appeals, to courts, have also
been tried and failed. The Wikipedia article on him follows in much more detail
his predicament than I have had reason to gather. [Update: There is an interesting article on Pollard in the March 18, 2013, New York Times.]
Lazar Kaganovich (1893-1991):
a fascist-like leader in Stalin’s government (this set of statements is by
no means intended to be in accord with the likes of the “Jew Watch” Web site). He was Stalin’s longest-running
associate in the Politburo (or whatever the name alternatively was used for the
highest council of the Soviet Union), from about
the time of the Bolsheviks’ first engaging in revolutionary activities pre-1917
to Stalin’s death in 1953, sometime after which Kaganovich was removed from
power after Nikita Khrushchev became premier. When he died at 97 in 1991, Kaganovich
was noted in The New York Times as
“one of Stalin’s closest aides and the last surviving Bolshevik leader who
joined the Communist Party before the Revolution” (July 27, 1991, p. 11). The
obit includes, “In the decades of Stalin’s bloody rule, Kaganovich offered the
despot the fealty of a total factotum. At the height of his fortunes he
administered the burgeoning nation’s transportation system and heavy industries
in behalf of Stalin. […] He also saw to some of the details that so often left
Stalin in petulant, vindictive moods.”
An apparently spineless
beneficiary of Stalin, “Kaganovich, born into a poor Jewish family in the
Ukraine, had become a worker at a shoe tannery …[and] seems to have been taken
up by Stalin, like Voroshilov, …when Stalin was [in the early years of building
his position in the party]” (Robert Conquest, Stalin: Breaker of Nations [New York: Viking, 1991], pp. 124-25).
“The truest Stalinist of [Stalin’s] promotions of the 1920s was Lazar
Kaganovich. He was brought in by Stalin in 1922 as leader of the ‘Organization
and Instruction’ Section of the Central Committee under the Secretariat [the
Secretariat was what certainly became Stalin’s own domain within the Soviet
government]. … Kaganovich, though to some degree shallow in his appreciation of
problems, was a brilliant administrator. A clear mind and a powerful will went
with a total lack of the restraints of humanity. If we have used the word ruthless as generally descriptive of Kirov, for Kaganovich it
must be taken quite literally—there was no ruth, no pity, at all in his
make-up. […] In the [Great] Purge [of 1936-38], he took the extreme line that
the Party’s interest justified everything. … When he himself was removed [from
power], in rather easier circumstances, in 1957, he telephoned the victor and
begged not to be shot. It is not difficult to conclude that we have here a
bully and a coward” (Robert Conquest, The
Great Terror: A Reassessment [New York: Oxford, 1990], p. 13.)
Kaganovich had an important role
in the famine wrought by the Soviet government in the Ukraine in
1929-33. In Robert Tucker’s meticulous account, Stalin in Power: The Revolution from Above, 1928-1941 (New York:
Norton, 1990), there is this detail: “According to an account based on archival
materials, Kaganovich on [a] trip ordered mass repressions against local party,
Soviet, and kolkhoz officials whom
he—following Stalin’s orders—held responsible for the breakdown of grain
deliveries from that area [which was a component of the broader famine-related
mayhem, set in motion by the Soviet government]” (p. 188; there are other
references to Kaganovich’s hand in things in this book).
Conquest makes a general
statement in a carefully detailed book, The
Harvest of Sorrow: Soviet Collectivization and the Terror-Famine (New York:
Oxford, 1986), “As to Stalin’s personal guilt [for the terror-famine] (and that
of Molotov, Kaganovich, Postyshev and the others)[,] it is true that, as with
Hitler’s responsibility for the Jewish holocaust [sic], we cannot document the responsibility in the sense that any
decree exists in which Stalin orders the famine. […] But the only possible
defence [sic], such as it is, would
be to assume that Stalin merely ordered excessive requisitions out of ignorance
of the true position, and had no mens rea
[deliberate, conscious intention of a criminal sort]; and this is
contradicted by the powerful considerations we have examined” (p. 328).
An obituary for Kaganovich in The New York Times (July 27, 1991, p.
11) states that “With Stalin having turned against and liquidated so many of
his associates, Kaganovich stands out in Bolshevik history for surviving at the
dictator’s side longer than anyone. His survival was all the more remarkable
because he was the only Jew to hold high office in Stalin’s final years in
power.” The reason Stalin may have spared Kaganovich from purges in the 1930s
was that Stalin had been having an affair (“was believed to be intimately
involved”) with Kaganovich’s sister. (It is to be noted that some—such as the
late chess champion Bobby Fischer, who was dismissed as a crank for saying
so—have characterized the Soviet Union as a Jewish conspiracy, at least in its
earlier years; but several of Lenin’s 1917 Politburo, whom Stalin later purged
for his own reasons, were Jewish, including Kamenev, Zinoviev, and Trotsky. And
Gengrikh Yagoda, head of Stalin’s secret police in the earlier 1930s, was
Jewish and [probably not for this reason] was eventually purged himself. But
among the Jewish members of the Politburo over the Soviet
Union’s first three or so decades, Kaganovich stands out for both
his longevity and his virtually fascist quality.)
David Berkowitz—half
Jewish according to his Wikipedia article, a serial killer in New York City in the late
1970s.
Meyer Lansky (1902-83)—a
noted functionary in organized crime through a good part of the twentieth
century.
So far, it sounds like a number
of people born Jews have been responsible for financial crimes involving
billions of dollars; state-induced deaths in the millions overseas; multiple local
killings of a psychopathic type; serious violation of U.S. state
security; and a role in organized crime for decades. [Remember, this is not the
main point.]
That sounds like a lot of crime. Millions of people were affected.
What other ethnic group has members that have that kind of negative reach from bad
apples? The Belgians? The Danish? The Irish? The French? Any of the African
countries? The Thai?
Wow—those Jews, some might say, when
they go bad, they can be potent in their wrongdoing. [Still not the main
point.]
Do we judge a whole group by a
few bad apples—even especially lethal
apples?
No, we don’t [--the main point].
Actually, that kind of bad generalization was tried with the Jews before, on less grounds in terms of select bad
apples—with the Holocaust. That wasn’t a great move.
Compare that to judging all people with mental illness (it routinely
gets said that some 25 percent of Americans suffer mental illness at some time
in their lives) by a few bad apples.
Still not good logic, huh?
Takeaway:
Statistically and broadly speaking, it makes no more or less sense to say a
person designated as among the mentally ill is likely to be a “serial shooter
off his meds” than to say “a horror of a cheap Jew” will wreak havoc in a
managerial role at a media company.
